This document contains 53 multiple choice questions related to various medical topics including: - Conditions involving the heart, lungs, abdomen, skin, and neurological system. - Common physical exam findings and their associated diagnoses such as heart murmurs, liver palpation, lung auscultation, and neurological signs. - Infectious diseases caused by bacteria, viruses, fungi and their presentations. - Deficiency diseases and their related physical findings. - Medical history questions that provide clues to diagnoses like Reiter's disease, gout, and transient ischemic attacks. The questions cover a wide breadth of content testing one's medical knowledge through case scenarios and physical exam/diagnostic findings.

1. © Irene Gold Associates, Inc. All rights to the material in this presentation are reserved.

2. 1. Which part of the case
history will yield the
most information in a
suspected case of
Reiter’s disease?
a. Family history
b. Past history
c. Chief complaint
d. Sexual history
2. Where is the most likely
location to find the
presence of tophi in a
patient with gout?
a. Fingers
b. Pinna
c. Knee
d. Big toe

3. 3. _____________ is the
etiology of Rocky
Mountain Spotted
Fever.
a. Bacteria
b. Virus
c. Rickettsia
d. Parasite
4. Which of the following
arteries is affected
during a transient
ischemic attack?
a. Carotid
b. Coronary
c. Femoral
d. Radial

4. 5. __________ alteration of
blood flow may result
in the inability to
understand language.
a. Posterior
communicating artery
b. Anterior cerebral artery
c. Cerebral artery
d. Carotid artery
6. While the patient is
supine with the head
extended off of the table
the doctor brings the
head into extension,
rotation, and lateral
flexion. Which of the
following is being
evaluated?
a.Axillary artery
b.Vertebral artery
c. Jugular vein
d.Anterior cerebral
artery

5. 7. A 22 year old female
was working out in a
gym and suddenly
faints, this is most likely
due to ___.
a. Subclavian Steal
syndrome
b. Spontaneous
Pneumothorax
c. Myocardial Infarction
d. Marfan’s Syndrome
8. Upon taking bilateral
blood pressure readings
you find that there is a
difference of 10-15%
from one side to the
other. Which of the
following is a probable
cause?
a.Venous insufficiency
b.Arterial insufficiency
c. Congestive Heart
Failure
d.Coarctation of the Aorta

6. 9. A female patient
presents with hard
circular lumps in her
hands and difficulty in
swallowing. Given these
findings what is the
most likely diagnosis?
a. Systemic lupus
erythematosus
b. Scleroderma
c. Amyotrophic lateral
sclerosis
d. Parkinson’s disease
10. A 35 year old female
patient presents with
complaints of joint pain
and polyarthritis. Upon
performing Murphy’s
sign you find that the
patient has pain. What
is most likely cause?
a. Systemic lupus
erythematosus
b. Scleroderma
c. Posterolateral
sclerosis
d. Parkinson’s disease

7. 11.Examination of the
patient reveals
yellowing of the skin.
Ophthalmic
examination reveals
yellow sclera. Which
organ is at fault?
a. Gallbladder
b. Kidney
c. Pancreas
d. Liver
12. Which of the following
best defines the
diagnosis of
anisocoria?
a. Dilated and fixed pupils
b. Constricted and
unresponsive pupils
c. Unequal pupil size
d. Absent red light reflex

8. 13. A female patient
presents with complaints
of gaining weight without
trying, intolerance to cold
temperatures, and
course/dry hair and
nails. What is an
additional clinical finding
that is most likely
present?
a. Sweating
b. Periorbital edema
c. Exophthalmosis
d. Hyperpigmented mouth
14. ______ is the cause of
ptosis, miosis, and
anhydrosis on one side of
the face?
a. CN III lesion
b. Pancoast tumor
c. Cluster headache
d. Temporal Arteritis

9. 15. Upon Ophthalmo-
scopic examination you
note the presence of
A-V nicking, flame and
splinter hemorrhages,
and cotton wool
exudates. What is the
most likely cause of
these findings?
a. Hypertensive
retinopathy
b. Diabetic retinopathy
c. Retinal detachment
d. Papilledema
16. The diaphragmatic
domes appear flat and
lower in which of the
following conditions?
a. Pneumonia
b. Pancoast Tumor
c. Tuberculosis
d. Emphysema

10. 17.______________ is the
most common cause of
a sensorineural
hearing loss.
a. Otitis externa
b. Meniere’s disease
c. Otitis media
d. Presbycussis
18. Upon laboratory
examination you find
that the patient has a
decreased TSH, a
decreased T3,
decreased T4, and
decreased growth
hormone. Which of the
following is the cause of
these lab results?
a. Hypopituitary
b. Hyperpituitary
c. Hypothyroid
d. Hyperthyroid

11. 19.Which of the following
findings is commonly
associated with viral
otitis media?
a. Perforated tympanic
membrane
b. Retracted tympanic
membrane
c. Eustachian tube
blockage
d. Pinna pain
20. A riboflavin
deficiency is likely to
cause which of the
following conditions to
occur?
a. Leukoplakia
b. Glossitis
c. Cheilosis
d. Macroglossia

12. 21._________ is commonly
associated with human
immunodeficiency
virus.
a. Candidiasis
b. Chancroid sores
c. Yellow frothy discharge
d. Hepatitis C
22.Which of the following
is not a risk factor for
candidiasis?
a. Diverticulitis
b. Pregnancy
c. Decreased intestinal
flora
d. Leukoplakia

13. 23. A smooth and glossy
tongue seen with
deficiency of B
vitamins is caused by
which of the following?
a. Pernicious anemia
b. Hemolytic anemia
c. Sickle cell anemia
d. Iron deficiency anemia
24. A large beefy tongue
is seen with ____.
a. Hypothyroidism
b. Hyperthyroidism
c. Hypercortisolism
d. Hypocortisolism

14. 25.Upon performing a
physical exam you note
a bruit is present over
the temporal artery.
Which of the following
is indicated?
a. Stroke
b. Giant cell arteritis
c. Migraine headache
d. Subclavian Steal
syndrome
26. Orchitis is most
commonly caused by
which of the following ?
a. Measles
b. Mumps
c. Varicella
d. Hemophilus

15. 27. A barrel appearance of
the thorax will be noted
in a patient affected by
which of the following?
a. Pneumonia
b. Emphysema
c. Pneumothorax
d. Atelectasis
28. What is the proper
location to
transilluminate the
frontal sinuses?
a. Superior/lateral
aspect of the orbit
b. Middle of the eyebrow
c. Medial orbit below the
eyebrow
d. 1” superior to the
eyebrow medially

16. 29. _________ breathing is
associated with
metabolic acidosis.
a. Cheyne stokes
b. Kussmaul’s
c. Biot’s
d. Brady’s
30. Which of the
following is the
percussive note of the
major portion of the
lung fields?
a. Dull
b. Flat
c. Tympanic
d. Resonate

17. 31. As you perform
bronchophony you
note clear sounds as
the patient says “99”.
What is the pathology
that causes this
finding?
a. Emphysema
b. Pneumonia
c. Bronchitis
d. Bronchiectasis
32. Increased tactile
fremitus is seen with
____.
a. Emphysema
b. Pneumothorax
c. Atelectasis
d. Pneumonia

18. 33. Hyper-resonance and
decreased tactile
fremitus on one side of
the chest is seen with
______.
a. Emphysema
b. Pneumonia
c. Pneumothorax
d. Atelectasis
34. A patient presents
with a low grade fever,
productive cough, night
sweats, and yellow
sputum. This is
indicative of ____________.
a. Pneumonia
b. Tuberculosis
c. Bronchitis
d. Bronchogenic
carcinoma

19. 35. Upon thoracic physical
examination you note
the presence of a friction
rub. Which of the
following is associated
with this finding?
a. Pleurisy
b. Pneumothorax
c. Tuberculosis
d. Pneumonia
36. Upon orthopedic
examination you ask the
patient to laterally bend
to one side while they
are in the standing
position. When they
perform this maneuver
they have pain on the
convex side. What is the
cause of this pain?
a. Intercostal neuralgia
b. Pleurisy
c. Pneumothorax
d. Pneumonia

20. 37. A previously healthy
18 year old male
suddenly complains of
stabbing chest pain that
is a 9/10 severity on the
pain scale. What is the
likely etiology of this
complaint?
a. Spontaneous
pneumothorax
b. Pleurisy
c. Myocardial Infarction
d. TIA
38. __________ is a type I
hypersensitivity
reaction and also
causes a rise in IgE.
a. Cytotoxic reaction
b. Lyme’s disease
c. Asthma
d. Emphysema

21. 39. Which of the following
conditions would
contribute to the
appearance of a normal
sized but low lying
liver?
a. Hepatocellular
carcinoma
b. Hepatitis
c. Emphysema
d. Pancoast tumor
40. A 68 year old male
presents with a non-
productive cough for the
past 60 days as well as
anorexia and weight
loss. What should be
suspected?
a. Bronchogenic
carcinoma
b. Pneumonia
c. Tuberculosis
d. Sarcoidosis

22. 41. A rash that breaks out
and follows along
parallel to the ribs is
most likely ________.
a. Tietze syndrome
b. Shingles
c. Intercostal neuralgia
d. Fungal infection
42. _______ stays dormant in
the dorsal root ganglia
of the patient.
a. Herpes simplex
b. Herpes zoster
c. Neurosyphilis
d. Hemophilus Ducreyi

23. 43. Upon taking a biopsy
from the lung tissue Reed
Sternberg cells are
present. What is the most
likely diagnosis given this
finding?
a. Bronchogenic carcinoma
b. Pancoast tumor
c. Miliary tuberculosis
d. Hodgkin’s disease
44. A child presents with
thick accumulations of
mucous in the lungs and
intestines. Upon
inspection you note a
barrel chest. They also
have pancreatic
insufficiency and
meconium ileus. What is
the diagnosis given these
findings?
a. Pneumonia
b. Cystic fibrosis
c. Nephroblastoma
d. Emphysema

24. 45. Which of the following
is a palpable finding in
a patient with
cardiomegaly?
a. Bounding apical pulse
b. Thrills in the 2nd
intercostal space
c. A bruit over Erb’s point
d. Lateral shift in the
apical pulse
46. Which of the
following is the best
method of palpating
the inferior structure
of the liver?
a. Patient supine with
deep inspiration
b. Patient supine upon
expiration
c. Patient supine upon
forced expiration
d. Patient in the lateral
recumbent position
upon inhalation.

25. 47. Which abdominal
examination is
performed to determine
the difference between
excess adipose tissue in
the abdomen and
ascites?
a. Murphy’s sign
b. Murphy’s test
c. Rovsing’s test
d. Fluid wave test
48.What is the most
common treatment for
myasthenia gravis?
a. Bed rest
b. Chemotherapy
c. Anticholinesterase
antibodies
d. B12 shots

26. 49. During a consultation
with a new adult patient
you find they have foul
smelling bowel
movements. Which of
the following is likely?
a. Celiac disease
b. Cystic fibrosis
c. Appendicitis
d. Gastric ulcer
50. Which of the following
presents with Pulsus
bisferiens?
a. Aortic regurgitation
b. Left ventricular failure
c. Mitral stenosis
d. Myocardial infarction

27. 51. Following recovery
from rheumatic fever
which of the following
is most likely to be
weakened in the
patient?
a. Myocardium
b. Pericardium
c. Endocardium
d. Epicardium
52.Which of the following
occurs prior to being
diagnosed with
bacterial endocarditis?
a. Mitral valve prolapse
b. Hypertension
c. Rubeola infection
d. Streptococcus infection

28. 53. Auscultating the
heart reveals a
murmur at the 5th
intercostal space mid
clavicular line during
systole. This murmur
is heard at the ____ of
the heart and will be
____.
a. Apex; high pitched
b. Apex; low pitched
c. Base; high pitched
d. Base; low pitched
54. A patient who
presents with both foot
drop and wrist drop is
most likely deficient in
which of the following?
a. Vitamin B12
b. Vitamin B6
c. Chromium
d. Folic Acid

29. 55. Which of the following
murmurs is present in
diastole?
a. Aortic stenosis
b. Pulmonic stenosis
c. Tricuspid regurgitation
d. Mitral stenosis
56. A congenital
narrowing proximal to
the vertebral artery is
known as which of the
following?
a. Subclavian steal
syndrome
b. Coarctation of the
aorta
c. Tetralogy of Fallot
d. Marfan’s Syndrome

30. 57. If the patient has
difficulty breathing
while in the supine
position that is relieved
when going into the
seated or standing
position it is called
_________.
a. Exertional dyspnea
b. Orthopnea
c. Strider
d. Hyperpnea
58. A patient has portal
hypertension and the
appearance of caput
medusa. These findings
are seen with which of
the following?
a. Left sided heart failure
b. Right sided heart failure
c. Pancreatitis
d. Acute appendicitis

31. 59. A patient presents with
complaints of recurring chest
pain. He describes the pain as a
feeling of something heavy
sitting on his chest. He doesn’t
know what brings it on but tells
you he gets the pain while he is
at rest. He also tells you that
this pain will go away after a
few minutes of continued rest.
What is the diagnosis?
a. Hemochromatosis
b.Simple angina
c. Complex angina
d.Printzmetal angina
60. A patient with
crushing chest pain is
asked to rest for a few
minutes while the
ambulance is on the
way, and the pain has
not subsided within
15 minutes. Which of
the following is the
best diagnosis?
a. Angina pectoris
b.Atypical angina
c. Myocardial
infarction
d.Aortic dissection

32. 61.Which of the
following is usually
detected on a routine
physical exam without
the use of an ECG?
a. Primary heart block
b. Secondary heart block
c. Atrial fibrillation
d. Block of bundle of HIS
62. ________ is indicated if
the patient presents
with yellowing of the
skin and the buccal
mucosa.
a. Polycythemia
b. Hemochromatosis
c. Osteogenesis
Imperfecta
d. Addison’s Disease

33. 63. Upon analyzing a KUB
study, you find that
there is a unilateral
sclerotic 3mm
radiopaque shadow
over the psoas muscle.
What does this
indicate?
a. Urolithiasis
b. Urethritis
c. Cholecystitis
d. Cholelithiasis
64. Which organ is
implicated if there is a
moderate increase in
alkaline phosphatase?
a. Liver
b. Heart
c. Pancreas
d. Spleen

34. 67. A patient presents with
complaints of
polydypsia and polyuria
but no polyphagia.
Which condition is most
likely?
a. Diabetes mellitus type I
b. Diabetes mellitus type II
c. Diabetes Insipidus
d. Pancreatitis
66. An elevation of
gamma-Glutamyl
Transpeptidase and
serum glutamic pyruvic
transaminase is an
indication for which of
the following?
a. Myocardial Infarction
b. Pancreatitis
c. Hepatitis
d. Appendicitis

35. 67. Which of the
following can be
contracted through the
oral/fecal route of
transmission?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Liver cirrhosis
68. Which of the following
conditions will cause
pain referral to the right
tip of the scapula?
a. Pancreatitis
b. Cholelithiasis
c. Splenomegaly
d. Hepatitis

36. 69. Which of the
following will result in
increased serum glucose
levels?
a. Cholecystitis
b. Pancreatic cancer
c. Acute appendicitis
d. Ovarian cancer
70. Which of the following
terms is used to
describe periumbilical
ecchymosis?
a. Grey turner sign
b. Cullen’s sign
c. Puddle sign
d. Minor’s sign

37. 71. An increased amount
of ADH will present
with which of the
following findings?
a. Increased specific
gravity
b. Glucosuria
c. Cloudy urine
d. Proteinuria
72. A patient that has
been diagnosed with
hyperparathyroidism
will most likely be
affected by which of the
following?
a. Urethritis
b. Big bulging eyes
c. Renal calculi
d. Increased bone density

38. 73. What is associated
with the over
proliferation of
helicobacter pylori
bacteria?
a. Systemic infection
b. Septic arthritis
c. Gastric reflux
d. Peptic ulcer
74. An elderly female
patient presents with
complaints of left lower
quadrant pain and chronic
constipation. What is the
most likely etiology of this
presentation?
a. Appendicitis
b. Inadequate fiber in the
diet
c. Hypersensitivity to
gluten
d. Duodenal ulcer

39. 75. Which of the
following is the most
common component
are kidney stones?
a. Uric acid
b. Calcium urates
c. Nitrates
d. Calcium oxalates
76. Which of the following
casts are normally
found upon urinalysis?
a. Fatty
b. Waxy
c. RBC
d. Hyaline

40. 77. Which of the
following conditions
could lead to
investigate pernicious
anemia in the patient?
a. Duodenal ulcer
b. Appendicitis
c. Pancreatitis
d. Hepatitis
78. A female patient who
recently gave birth
presents with
complaints of
incontinence when she
laughs. What type of
incontinence is
described?
a. Urge
b. Stress
c. Overflow
d. Physiologic

41. 79. A woman who is pregnant
for the first time presents
with bilateral pitting edema
in the lower extremities.
What other signs are related
to this condition?
a. Hypertension; proteinuria;
seizures
b. Hypertension; proteinuria;
vomiting
c. Hypotension; proteinuria;
seizures
a. Hypotension; proteinuria;
vomiting
80. Pelvic inflammatory
disease will not present
with ______.
a. Cervical discharge
b. Bloody discharge
c. Fever
d. Purulent discharge

42. 81. A patient states that
she is unable to urinate.
While you are
performing your
examination the patient
has a yellow discharge
that is expelled. What
is the most appropriate
follow up step?
a. Catheterization
b. Surgical consultation
c. Bacterial culture
d. Hair analysis
82. A 36 year old male
patient presents with
gynecomastia. Which of
the following is the most
likely cause of this
presentation?
a. Addison’s disease
b. Cushing syndrome
c. Inguinal hernia
d. Testicular cancer

43. 83. A pediatric patient
presents with tortuous
dilation of the
spermatic veins. What
is the diagnosis?
a. Spermatocele
b. Varicocele
c. Hydrocele
d. Hernia
84. Upon palpation of the
testicle you find a single
nodule that is painless to
the patient. What should
be suspected?
a. Hydrocele
b. Varicocele
c. Testicular cancer
d. Epididymitis

44. 85. A painless, moveable,
small lump superior to
the testicle is most
likely a
___________________.
a. Hydrocele
b. Spermatocele
c. Varicocele
d. Prostatitis
86. Loss of the median
sulcus of the prostate
upon digital
examination is most
likely to be caused by
_________.
a. Acute Prostatitis
b. Prostatic carcinoma
c. Benign prostatic
Hyperplasia
d. Chronic Prostatitis

45. 87.Prostatic carcinoma
will present with
which of the following
palpatory findings?
a. Smooth; non tender
b. Tender; soft
c. Firm; non tender
d. Hard; nodular
88.A hard, moveable non-
painful lymph node is
palpated above the left
clavicle. This is most
likely a ______.
a. Virchow’s node
b. Haygarth's node
c. Pancoast tumor
d. Bouchard’s node

46. 89. A patient presents
with thrombocyto-
penia and Petechiae at
the ankles. What is the
most likely diagnosis?
a. Stasis dermatitis
b. Liver cirrhosis
c. Pancreatitis
d. Congestive heart
failure
90. A bacterial infection
will produce the
following change in the
white blood cells?
a. Neutrophilia
b. Lymphocytosis
c. Monocytosis
d. Basophilia

47. 91. Lymphocytosis is a
common finding in a
patient with a/an____.
a. Bacterial infection
b. Chronic infection
c. Allergies
d. Viral infection
92. Which of the following
conditions presents
with microcytic, target
cells.
a. Sickle cell anemia
b. Thalassemia
c. Aplastic anemia
d. Iron deficiency anemia

48. 93. Laboratory
examination reveals the
presence of decreased
RBC’s that are
microcytic and
hypochromic. What is
the diagnosis?
a. Iron deficiency anemia
b. Megaloblastic anemia
c. Sickle cell anemia
d. Aplastic anemia
94. A patient with chronic
iron deficiency anemia
will present with which
of the following
combinations of
laboratory findings?
a. Decreased iron;
decreased TIBC
b. Decreased iron;
increased TIBC
c. Decreased copper;
decreased TIBC
d. Decreased copper;
increased TIBC

49. 95. Prolonged periods of
fasting will produce
excess ______ in the
urine.
a. Glucose
b. Protein
c. Ketones
d. Urobilinogen
96. _____ is the best
laboratory test to
monitor the health of
the kidney.
a. CPK
b. CK-MM
c. Creatine
d. Creatinine

50. 97. A deficiency in
___________ will cause
chronic muscle
cramping.
a. Protein
b. Potassium
c. Phosphorus
d. Vitamin C
98. When performing
Weber’s test the sound
lateralizes to the right
ear. While performing
the Rinne test you note
there is a positive in
the right ear. This
indicates _____
deafness.
a. Right sensorineural
b. Left sensorineural
c. Right conductive
d. Left conductive

51. 99. An increase in CK-MM
will likely indicate
which of the following
diseases?
a. Myocardial infarction
b. Muscular dystrophy
c. Stroke
d. Kidney stones
100. Staphylococcus aureus
infection is responsible
for which of the
following conditions?
a. Meningitis
b. Toxic Shock Syndrome
c. Rheumatic fever
d. Glomerulonephritis

52. 101. Which of the
following conditions
will cause a blood
pressure of 190/130
and cotton wool
exudates in the eyes?
a. Malignant hypertension
b. Benign renal
hypertension
c. Systolic hypertension
d. Myocardial infarction
102. You shine the light in
the right eye and the
right pupil contracts,
but the left pupil does
not contract. You
deduce from this
finding that CN___ on
the ___ is at fault.
a. II; right
b. III; right
c. II; left
d. III; left

53. 103. The reason for
performing Hallpike’s
maneuver on a patient
is to determine ____.
a. Vertigo
b. Proprioception
c. Cervical sprain/strain
d. Balance
104. A young child presents with
torsion of the spermatic cord.
Which of the following is
correct?
a. It would feel like a bag of
worms and the patient should
be placed on bed rest.
b. There is a congenital anomaly
and the child needs to go to a
pediatrician.
c. The patient should be sent to
the emergency room
immediately.
d. The sacrum should be
adjusted.

54. 105. Which of the
following is a true
statement about
Raynaud’s
phenomenon?
a. Brought on by
emotional stress.
b. Turns the hands red
then blue then pale.
c. Occurs as a primary
disease.
d. It is generally
unilateral.
106. Cystic fibrosis most
commonly affects
which of the following
glands?
a. Mucous glands
b. Sebaceous
c. Apocrine
d. Eccrine(sweat)

55. 107. The patient with
thrombocytopenia
purpura would also
have?
a. Gastric carcinoma
b. Petechiae and stasis
dermatitis
c. Cirrhosis of the liver
d. Petechiae and
mucosal bleeding